Identification of Risk Factors for Abnormal Postoperative Chemistry Labs after Primary Shoulder Arthroplasty

Document Type: RESEARCH PAPER

Authors

1 Sidney Kimmel Medical College at Thomas Jefferson University, Department of Orthopaedics Surgery, Philadelphia, PA

2 The Rothman Institute, Thomas Jefferson University, 925 Chestnut St. 5th Floor, Philadelphia, PA

Abstract

Purpose
Purpose
The purpose of this study was to determine patient-specific risk factors and clinical intervention rates for abnormal postoperative Chem-7 panels in shoulder arthroplasty patients.

Methods
Retrospectively, all primary anatomic total (aTSA) and reverse shoulder (RTSA) arthroplasties (between 2007-2013) performed at a single institution were identified. All patients underwent routine preoperative and postoperative day one (POD1) chemistry panels. Each clinically significant component of the Chem-7 panel was independently evaluated using a multivariate analysis to identify risk factors for abnormal results. Associated clinical intervention rates were also calculated.

Results
Data from 1,012 patients (248 RTSA; 764 aTSA) was analyzed. 5.4% of patients had at least one preoperative abnormal chemistry result. On multivariate analysis, patients with abnormal preoperative Chem-7 labs and a history of renal disease had significantly increased risk for abnormal POD1 labs (p <0.001). Although 25.6% (259/1,012) of patients had at least one abnormal POD1 lab result, the total postoperative clinical intervention rate was 15.1% (39/259).

Conclusion
Renal disease and a preoperative abnormal chemistry result are important risk factors for abnormal postoperative Chem-7. Optimizing renal status and correcting abnormal blood chemistry results preoperatively may reduce the incidence of abnormal postoperative chemistry results.

Keywords

Main Subjects


1. Kraft MD, Btaiche IF, Sacks GS, Kudsk KA. Treatment
of electrolyte disorders in adult patients in the
intensive care unit. Am J Health Syst Pharm. 2005;
62(16):1663-82.
2. Tambe AA, Hill R, Livesley PJ. Post-operative
hyponatraemia in orthopaedic injury. Injury. 2003;
34(4):253-5.
3. Anthony CA, Westermann RW, Gao Y, Pugely AJ,
Wolf BR, Hettrich CM. What are risk factors for 30-
day morbidity and transfusion in total shoulder
arthroplasty? A review of 1922 cases. Clin Orthop
Relat Res. 2015; 473(6):2099-105.
4. Jiang JJ, Toor AS, Shi LL, Koh JL. Analysis of perioperative
complications in patients after total shoulder
arthroplasty and reverse total shoulder arthroplasty.
J Shoulder Elbow Surg. 2014; 23(12):1852-9.
5. Waterman BR, Dunn JC, Bader J, Urrea L, Schoenfeld
AJ, Belmont PJ Jr. Thirty-day morbidity and mortality
after elective total shoulder arthroplasty: patientbased
and surgical risk factors. J Shoulder Elbow Surg.
2015; 24(1):24-30.
6. Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz
SM. Prevalence and projections of total shoulder and
elbow arthroplasty in the United States to 2015. J
Shoulder Elbow Surg. 2010; 19(8):1115-20.
7. Freeborn DK, Baer D, Greenlick MR, Bailey JW.
Determinants of medical care utilization: physicians’
use of laboratory services. Am J Public Health. 1972;
62(6):846-53.
8. Schleicher E. The clinical chemistry laboratory:
current status, problems and diagnostic prospects.
Anal Bioanal Chem. 2006; 384(1):124-31.
9. Kreines A, McMillan S, Ford E, Dingle A. Reverse total
shoulder arthroplasty for the treatment of synovial
chondromatosis: a case report and review of the
literature. Arch Bone Jt Surg. 2017; 5(2):117-20.
10. Epstein M. Aging and the kidney. J Am Soc Nephrol.
1996; 7(8):1106-22.
11. Murphy AM, Tunitsky-Bitton E, Krlin RM, Barber
MD, Goldman HB. Utility of postoperative laboratory
studies after female pelvic reconstructive surgery. Am
J Obstet Gynecol. 2013; 209(4):363.e1-5.

12. Perrone RD, Madias NE, Levey AS. Serum creatinine
as an index of renal function: new insights into old
concepts. Clin Chem. 1992; 38(10):1933-53.
13. Kamath AF, McAuliffe CL, Kosseim LM, Pio F, Hume E.
Malnutrition in joint arthroplasty: prospective study
indicates risk of unplanned ICU admission. Arch Bone
Jt Surg. 2016; 4(2):128-31.
14. Feinfeld DA, Bargouthi H, Niaz Q, Carvounis CP.
Massive and disproportionate elevation of blood urea
nitrogen in acute azotemia. Int Urol Nephrol. 2002;
34(1):143-5.
15. Stark JL. BUN/creatinine: your keys to kidney function.
Nursing. 1980; 10(5):33-8.
16. Stookey JD, Pieper CF, Cohen HJ. Is the prevalence of
dehydration among community-dwelling older adults
really low? Informing current debate over the fluid
recommendation for adults aged 70+years. Public
Health Nutr. 2005; 8(8):1275-85.
17. Robinson BE, Weber H. Dehydration despite drinking:
beyond the BUN/Creatinine ratio. J Am Med Dir Assoc.
2004; 5(2 Suppl):S67-71.
18. Thomas DR, Tariq SH, Makhdomm S, Haddad R,
Moinuddin A. Physician misdiagnosis of dehydration
in older adults. J Am Med Dir Assoc. 2004; 5(2
Suppl):S30-4.